Predictors of Developing a Complex Course of Osteomyelitis in Patients with Sickle Cell Anaemia

Objective: Despite the numerous advances in management strategies, treating osteomyelitis in individuals with sickle cell disease remains a significant challenge, leading to severe long-term consequences. This study aimed to assess the key factors potentially linked to a complex progression of osteomyelitis in patients diagnosed with sickle cell disease. Methods: A cohort of thirty-four patients was identified, and their progress was monitored over a span of twelve months, during a ten-year period (2010-2020). The variables under investigation encompassed demographic and clinical traits, laboratory analyses, imaging data, as well as the strategies employed for treatment. Results: The risk prediction model has pinpointed five factors (severity of sickle cell disease, involvement of lower limbs, presence of bacteraemia, MRI findings, and utilization of surgical debridement) that exhibited an Area Under the Curve (AUC) exceeding 0.7. Causative organisms were identified in 9 out of the total cases, constituting 26.47% of the patient cohort. Among the 34 patients, 17 displayed a severe course of sickle cell disease (AUC 7.88), with MRI being highlighted as a valuable contributing factor (AUC 7.88). Furthermore, thirteen patients (38.2%) underwent surgical debridement, a procedure that yielded a statistically significant P-value of 0.012 and an AUC of 0.714. Conclusion: Osteomyelitis within the context of severe sickle cell disease, particularly when accompanied by lower extremity infection, bacteraemia, and positive MRI findings, and necessitating surgical debridement, emerges as a cluster of risk factors predisposing individuals to osteomyelitis relapse and a more intricate disease trajectory. Keywords: Sickle cell disease, Osteomyelitis, Disease Severity, Debridement, bacteraemi

Mycobacterium farcinogenes osteomyelitis of the proximal tibia: A case report

Non-tuberculous mycobacteria (NTM) are an unusual cause of osteomyelitis. Mycobacterium farcinogenes is an uncommon cause of human disease. We describe here the first case of M. farcinogenes osteomyelitis in a 49-year-old man who underwent left knee anterior cruciate ligament and medial meniscal repair which was complicated by recurrent septic arthritis and surgical site infection. As a consequence, he underwent multiple surgical debridements. Ultimately, left proximal tibial osteomyelitis was diagnosed and M. farcinogenes was recovered from the tissue biopsy culture. Clinical improvement was achieved following surgical removal of the prosthesis along with prolonged combination antimicrobial therapy

SARS-CoV-2 vaccination modelling for safe surgery to save lives: data from an international prospective cohort study

Background: Preoperative SARS-CoV-2 vaccination could support safer elective surgery. Vaccine numbers are limited so this study aimed to inform their prioritization by modelling. Methods: The primary outcome was the number needed to vaccinate (NNV) to prevent one COVID-19-related death in 1 year. NNVs were based on postoperative SARS-CoV-2 rates and mortality in an international cohort study (surgical patients), and community SARS-CoV-2 incidence and case fatality data (general population). NNV estimates were stratified by age (18-49, 50-69, 70 or more years) and type of surgery. Best- and worst-case scenarios were used to describe uncertainty. Results: NNVs were more favourable in surgical patients than the general population. The most favourable NNVs were in patients aged 70 years or more needing cancer surgery (351; best case 196, worst case 816) or non-cancer surgery (733; best case 407, worst case 1664). Both exceeded the NNV in the general population (1840; best case 1196, worst case 3066). NNVs for surgical patients remained favourable at a range of SARS-CoV-2 incidence rates in sensitivity analysis modelling. Globally, prioritizing preoperative vaccination of patients needing elective surgery ahead of the general population could prevent an additional 58 687 (best case 115 007, worst case 20 177) COVID-19-related deaths in 1 year. Conclusion: As global roll out of SARS-CoV-2 vaccination proceeds, patients needing elective surgery should be prioritized ahead of the general population